Just hypermobility?

[Coley6]

Hi there,

I am trying my best to understand hypermobility and multiple muscle strains.

I am 25 years old, otherwise healthy. I am a competitive highland dancer (practice 3hrs/wk). On non-dance days I train at the gym - weights, cardio (recumbent bike only), core and lots of strtching. I have a crazy shin splint in my left. I recently had a bone scan to rule out a stress fracture (no fracture) and my sports med doctor figured it is just an overuse injury. I rested it frl
dance for 2 months, just returned to dance two weeks ago and the pain is back like before. In my rest period I only did my usual gym routine.

I see a Physio every week. She ultrasounds it and tries to help the muscles relax. I have very high tone in my lower legs, they feel like logs, causing my dance to be really sloppy. My Physio has told me that i have very unstable and hypermobile joints. All my home exercises aimed at strenghtening but I seem to be getting no where. I am so weak and pull muscles all the time. I keep subluxing my shoulder with minimal effort, twisting my ankles, hurting my knees etc. All the muscles around my joints are tight no matter how carefully I stretch.

I want to know of there are any other techniques out there I can try to reduce these injuries and the high tone ( it is uncomfortable, I lose sleep and get spasms). My sports doc said all my blood test results were normal, and told me to stick with the (boring) bike, keep working with Physio to strengthen etc. My problems seem to get worse and worse with activity, but I like leading a physically active lifestyle and I hate not beiing able to dance. If anyone has more info/treatment ideas I would be grateful thank you )
(I also see a massage therapist; and use epsom salts in the bath; and drink lots of water and potassium is normal).
Thanks for any ideas


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[gcoe]

Does your physio say you are generally hypermobile?

It sounds like it but fill us in on this. General hypermobility may may be linked to a particular connective tissue disease which often accounts for the more extreme versions of general hypermobility or you may just have general hypermobility - in the normal world where at one end of the curve you have people with very little movement at their joints and at the end you have a lot of movement.

If your muscles are really tight and overactive two reasons come to mind:

• your muscles are trying to compensate for your hypermobility - as the ligaments aren't holding your joints together properly your muscles are instead
• You are overtraining in the gym. What are you doing in the gym?

You should be able to maintain an active lifestyle and it would do you no good to give up physical activity. However you may need to modify some activities atleast in the interim.

As far as the physio goes I don't know what they are doing for you re: strengthening and stretching exs. However the ultrasound may not be doing very much - ultrasound doesn't have much evidence as an effective treatment for these sorts of problems. has the physio had a good look at your posture and movement for muscle imbalances - ie where one muscle is shortened and tight while it's opposing muscle is lengthened and weak.

Have you heard of the Feldenrkrais method or the Alexander Technique? These are two systems that are about improving the way you use your body in your posture and movement. They are really about education rather than therapy. Either method may be helpful and worth trying. Of the two, the Feldenkrais method is more dynamic and may suit you better. You could give either one of them a trial over a few sessions and see if it makes a difference. Both of them have some evidence for their effectiveness in chronic problems.

[Coley6]

My physio has said that I am generally just hypermobile. She has said that my joints are ‘loose’ and that I hyperextend all of them.

My workout (every other day) looks like this:
*I first spend between 30 – 45 minutes of the recumbent bike.
*I do weights on the machines (very low weights, I have built up very little strength. I saw a personal trainer who helped me figure out the proper use and advised me to stay within 70% of my range of motion -or I seem to hyperextend certain movements. I don’t feel I’ve gotten any stronger over the last year and have only increased weight by 5%. Every time I try I pull a muscle.)
*Core exercises (my physio has sent me to a pilates school, where we do very careful core work, so I spend about 10 minutes doing some core exercises.
*stretches (basic for all muscles).

I Highland


My physio has given me some exercises, that are a bit hard to describe, but I’ll try. Because of the shin splints she would like me to strengthen my calves, standing on one leg I do ten repetitions on each leg of getting onto my tippytoes. For my knees I do something she calls the clamshell. For my back and shoulders we have done a modified ‘superman’ where you are up on your arms and knees and you must extend one leg back and the opposite arm forward, balance for 5 seconds, and alternate sides. She’s modified it for me to doing just the arms, then just the legs because I lose my balance easily. For my ankles I have been doing exercises on a balance board. My neck and shoulder blades get very tight so I have a foam roller that I lie on and have some exercises where I move my arms back and forth and it seems to relieve the tension. For my shoulders we use a theraband exercises (elbows in, hands hold the elastic, palms down and you pull the elastic away carefully, then return). For my hamstrings and back I lie on my back with a stability ball under my ankles, then lift my pelvis and hold. I basically bring my physio booklet with me everywhere I go to help me remember all the exercises I need to do at the gym and home. I am pretty compliant. My physio has checked a few times that I am doing them correctly. She usually has to correct me on my positions. Without a mirror I have no idea what my body is doing…thank goodness there’s a big mirror at my gym.


I’m really determined to maintain a healthy lifestyle, and I don’t want to give up any of my physical activity. I know my physio isn’t thrilled about my dancing, and she has advised against every other activity except the bike and her careful plan, which is fine I was just hoping that all these muscle pulls and spasms would decrease.

When I go to physio it is mostly passive (for me). She stretches my calves, ultrasounds and massages the area around them. Or when we work on my shoulder she ultrasounds, passively stretches my shoulder, and pushes on the front of my shoulder. It gets better, but is very time limited. Especially with my shoulder (it is my right and I am right handed) I hurt it somehow every week doing very simple tasks (like cutting a piece of meat).


It’s a bit embarrassing to be always pulling muscles and having to be so careful at my age. And it takes a lot of time to try to get my legs to somewhat relax so that I’m comfortable enough to sleep. It feels like it’s always getting worse!


I’m not sure if I should end physio as I am making little and slow progress, or try a different physio? It’s sounding like my body is just built this way and maybe I just need to be careful and accept that.


Thank you for your help – I will certainly look into the techniques you have mentioned.

[gcoe]

*I first spend between 30 – 45 minutes of the recumbent bike.

This is good. Keeping your aerobic fitness up is really important.

*I do weights on the machines (very low weights, I have built up very little strength. I saw a personal trainer who helped me figure out the proper use and advised me to stay within 70% of my range of motion -or I seem to hyperextend certain movements. I don’t feel I’ve gotten any stronger over the last year and have only increased weight by 5%. Every time I try I pull a muscle.)

Weights should be good in theory. The most likely reason you are not building up strength is that the weight intensity is too low. If you want to strengthen things you have to be in the range of 8-12 reps where on the last rep you really can't do much more. HOWEVER if you are having so many problems this may not be feasible and I would be guided by your physio and personal trainer. Have you discussed your lack of progress with your weights?

*Core exercises (my physio has sent me to a pilates school, where we do very careful core work, so I spend about 10 minutes doing some core exercises.

This is good! Should be helpful

*stretches (basic for all muscles).

So are you doing these at the end of your exercise session? You probably should be going very easy on them just relaxing into the stretch and maintaining the stretch for 30 sec or so. You probably don't want to be over stretching.

As an afterthought, given that you have generalised hypermobility there is a group of conditions called Ehlers-Danlos Syndrome. I am not saying you have this but as you are having so many problems this might be worth getting checked out medically.

Also: do have a think about the Feldenkrais/Alexander idea

[roycar]

hi there.

I also am "hypermobile". I was diagnosed with "joint hypermobility syndrome" by a rheumatologist a couple of years ago. I said"what can I do to get rid of the pain?" His answer? "Exercise!"

Very vague do you think?

I've suffered with aches and pains throughtout my various joints and loads and loads of injuries over the years. As I was growing up I always seemed to be injured and sore etc while all my friends never had any trouble. Generally I'nm able to control/manage my aches and pains and I've only really had one "bad" injury that I could connect to my hypermobility (tore my acl).

i agree with gcoe regarding posture and body awareness. if there was one thing that i would tell you to focus on this would be it. hypermobile people tend to have quite poor posture, slumped with a forward neck, this is the body's attempt to find some degree of stability where it hangs off the hypermobile ligaments. with this you have a lot of muscular imbalances where there are some muscles that are tight and strong and others are long and weak. generally your "postural" muscles are weak and poorly active. By postural muscles I mean the muscles that should be active all the time, working in the background to try to keep your body in a decent allignment. retraining these is the starting point of rehab for someone who is hypermobile. this doesnt just apply to your "core". it should also involve your shoulder, hip, knee etc.training should start statically and pregress as appropriate to dynamic activites.

obviously structures that are tight should be stretched, structures that are weak should be strengthened but the important part is the assessment to understand what needs what done. a biomechanical assessment may help if hypermobility in the foot leads to poor control when walking/running/dancing.

you cant cure hypermobility but you can certainly go some way to managing it. i still have aches and pains from time to time but i'm aware of why im sore and this helps me to deal with it. i play football rugby etc. i know im at more of a risk of injury because im hypermobile and i've inherently poor body awareness but i love sport so im not gonna give it up! improving your body awareness and general joint and body stability takes time and is an ongoing process. you wont get to a level where you can just stop. you'll have to continue with your "rehab" indefinitely but you should be able to dance etc. i have had the luxury of learning from a physio who was qite experienced in this condition so if you can find someone who has a background in it you may get more from it.

i hope all goes well. try not to lose heart.

[Coley6]

Thank you both for your replies! They've both given me some questions to discuss with my physiotherapist.

I talked to my physio about my lack of progress with weight training two weeks ago, and she suggested 'pyramid' training. This is going well for my leg muscles, I think they are actually getting a bit stronger! My shoulder doesnt like it, so I'll just keep doing what I can so that it doesn't lose any strength.

I will keep up with my daily exercise. I had to skip dance tonight, my calf is in a lot of pain from my last session, so I thought I'd better not overdo it and just use the bike tonight. I really love my dancing and do not want to give it up. I have a competition May 16 that I hope I can do!!

I typically hold my stretches for about a minute. I certainly have a difficult time knowing if I am stretching it too hard (over-stretcing). I'll try to be a bit more careful. I do my stretches right after my workout.

As far as rehab goes, do either of you have any idea on how long I should be continuing physio? I'm embarrased, it seems like my physio helps fix one problem, then another occurs and I have to go back. I don't want to be a burden to my physio, but she always treats me and says it's appropriate to come. I just feel like I might have to go forever. I don't have any friends with a similar issue who never get discharged from physio. gcoe - have you ever had patients who have similar issues and are always returning?

Thanks again for all your help, I've felt very lost with all this until now.

[gcoe]

I don't have any friends with a similar issue who never get discharged from physio.

Yes I think it is true what Roycar says and Roycar seems to have a good perspective both as a patient and as a physio. There definitely is a group of patients with hypermobility who are "accident prone" and keep some of us in business :-)

However I don't think you should feel embarrassed about seeking a lot of help from the physio. - not at all. I think it is great that you are trying to sought things out. No one is forcing you to go but if it is helping you be more functional and keeping you doing the dance you enjoy then does it need to be problem? Here is an analogy: competitive marathon runners are often constantly attending physio for pulling this and overusing that tendon and muscle. But the keep going because the physio helps keep them on the track - without it they may have to retire. The physio can help not only with immediate treatment but also with preventing future problems.

If it is costing you too much or if you feel you are being overserviced - that is receiving treatment then that is not a good thing. But if you are using physio and gym as a strategy to keep you happy and enjoying your dance then I can't see a problem.

It is important to have good rapport with your physio. You shouldn't feel you are being judged for keeping turning up with a new injury. As long as you are taking responsibility for preventing injury when you can - warm ups, postural training, keeping your muscles strong etc. then no one should be judging you. and remember your physio is earning and income.

[oceanid]

Hi,

I am also diagnosed with hypermobile joints. I'm a student studying in canada and the doctor also recommanded exercise to improve the muscle tone.

I tried jogging for a start... But kept twisting my ankle {not badly that I cant walk hmmm around 5-20 minutes later} or I'll trip and fall etc. What worries me the most it that my joints at my shoulder keeps sub-laxting out of the sockets.

I am curious since you all seem to know the best course of action as you either deals with people with this disorder of also have this condition. What kind of exercises and programs should I go for to increase the muscle tone overall?

Please let me know.

Thanks

[Coley6]

Hi there,

I've learned a ton in the last year about hypermobility etc. so just as a patient I thought I'd let you know what's keeping me (somewhat) together!

I've found that exercises that have low impact on your joints (recumbant bike, elliptical and even walking) have been a good way for me to maintain my physical activity and avoid pain and injury. I also do weight training on the machines. I like this instead of free weights because I found that it reduced my injuries. I really don't push it as far as weights go, I increase the weight slowly or I find I sublux my shoulders or hurt my back. And stretching...so important. I had a physio teach me how to do everything properly as I don't have great body awareness. I also use the mirrors a lot at the gym to see what my body is actually doing so I can correct the problem. I do pilates once a week which has been awesome for building core strength. I do some of the exercises at my daily workout to maintain the strength.

I've found that I just have to exercise carefully and really think about what I'm doing. It has taken a long time but I am finally building strength without constantly injuring myself. It was looking so bleak a year ago when I just kept injuring & reinjuring. I've realised that it is a lifelong commitment to a balanced workout program. Seriously, just keep moving in any way you can!

[oceanid]

Hi,

thanks for replying. Does pilates really helps with this?? What about yoga?? Would it be advisable to join martial arts? I always wanted to learn a little of martial arts.. However due to obvious reasons I have never attempted to do so.

Do your joints also like.. erm.. progressively sublux? Few years back only my right shoulder subluxed {which can be both involuntary or on voluntary basis} However.. This past few years, I also noticed that my left shoulder begin to sublux {involuntarily}.

Is there any dietary things that we should take more/less that could help with this?

[Coley6]

I don't think martial arts are a great idea. I did taekwondo with our Brownies (girl guides) a few weeks ago and imaginary punching really hurt my neck and shoulder. I think it might be too much impact. However, if you are very aware of what your body can do it might be ok (if you are quite careful).

I'm just getting into yoga. I think again we must be careful as to not bend our joints in all sorts of weird ways. I've had instructors that encourage this because they think you are just flexible, but you could be making it worse. Ive done a few sessions and I like the stretching because I actually have really high muscle tone and spasms, so stretching for me is always helpful. Pilates is great - again watch that you don't overdo it or go outside a normal range of motion. But strengthening your core is your best way to help the rest of your body build strength and stability.

I have the exact same problem with my shoulders! My right subluxes all the time and now my left is starting to act up and do the same! It's so frustrating. Though I have built a bit of strength this last year which i think is helping. It just sucks for trying to sleep. I can't sleep on either side!

Nutrition - omega 3 (fish oil capsules) were recommended as they help with lubricating the joints (apparently). I've been taking promega every day as i don't eat fish. I was also told to get adequate protein and make sure to eat lots of fruits and vegetables! I think overall good nutrition just gives a solid foundation for a body that is constantly trying to heal itself!

[oceanid]

Wow.. Glad to know that someone knows exactly whats going on and how it feels like!

I think the most problematic ones are mainly my shoulder, elbow {VERY hypermobile} and ankles mainly.. Do you also get a snapping sound when u move certain joints? Like the wrist and ankles? I never had that on my wrist till very very recently {past few months} but I dont think that my wrist and hands are hypermobile.. I cant touch my arm with my thumb and all..

Thanks for your advises! Will look into going into pilates.. I tried a version once.. but it was a mixture of yoga and pilates.. Kinda costly to take up the classes though.. Hmm..

[gcoe]

Thought I would chip in with a professional viewpoint. On the whole I think Coley 6 is giving fantastic advice particularly with the low impact fitness and doing progrssive resistance training but going easy on the intensity particularly to start off with. I agree that as a general rule using weight machines is probably a lot safer for you than using free weights. However just be aware that the quality of the design of the machines also matters. For example overhead press machines often put the shoulder in an awkward starting position (too horizontally abductrd is the fancy term) and this can strain a weak shoulder joint capsulr which ciuld possibly cause a subluxation or even a dislocation of a hypermobile shoulder joint. Personally I would suggest that if you decide to do weights for strengthening (and this is a good thing to do for your condition) that you invest in some profressional help to get you started and maybe for the odd review to ensure all the exercises will maximise benefit and minmise risk of injury

With pilates -probably all good! Yoga -well that comes in many guises so not all is bad but on the whole the last thing you need to be doing is making yourself more flexible! - so i would steer clear. Something like Tai chi is unlikely to do you any harm and can improve your balance and posture -all good . But other martial arts - definitely steer clear

With the diet advice this is beyond my scope. But health professionals generally endorse eating F & Js. I don't thnk it is true that omega 3 oil improves joint lubrication. However this group of fats appear to be generally beneficial for preventing and controlling chronic diseases and it may be that as they exert an anti inflammatory effect on the body this is why people with joint pain often seem to vouch for supplementing their diet. Using fish oil pills rather than injesting oily fish may not be as good -so often the way wiith "food supplements" and we need more high quality trials to be sure about the benefits at this stage of consuming omega 3 oil. So far no sign that it does any harm. Anyway take opinions on the nutrition issue as an educated lay person rather than in my professional capacity -a dietician is the best soirce of advice on this.

[oceanid]

Good to know

Would it be good to invest on those wrist weights?? the type where you can strap on and off {adjustable weights} when doing normal day to day activity then? I was actually thinking of getting a pair for the wrist and for the ankles..

What about things like aerobic exercises? Would that be helpful in anyway?

Sorry I'm not sure what does the Acronym F and J's stand for... could you please clarify that? Much appreciated

Thanks!